International Orthopaedics最新文献

This study evaluated the outcomes of double mobility trapeziometacarpal prostheses for treating osteoarthritis (OA) of the trapeziometacarpal (TMC) joint. A prospective observational analysis was conducted on 150 implants with a maximum follow-up of four years, including a clinical and radiographic assessment and an evaluation of complications. The results indicate a prosthesis survival rate of 97.9% after the first two years post-surgery, calculated using the Kaplan-Meier method. Significant improvements were observed in pain reduction (mean VAS at 3 months post-surgery 2,9 and 1.5 after 6 months), hand grip strength (25.93 kg at 6 months post-surgery), and range of motion (Kapandji score from 8.8 to 9.2, comparing the preoperative mean with the mean after the first postoperative month). The complication rate was low, with only two cases of cup migration and one case of trapezium resorption. Patient satisfaction was high due to the rapid functional recovery and reduced invasiveness compared to traditional techniques. Double-mobility prostheses offer a highly effective treatment for stage II and III TMC OA according to the Eaton-Littler classification, with minimal need for revision surgeries.

Introduction: Two-stage revision of total hip arthroplasty (THA) remains the gold standard for periprosthetic joint infection (PJI). Trabecular Metal (TM) offers a valuable option for acetabular reconstruction, but evidence in septic revision THA (rTHA) is scarce. This study evaluated outcomes of TM implants in two-stage rTHA for infection, hypothesizing results comparable to existing literature, especially in cases with major bone loss.

Materials and method: We retrospectively analyzed 32 two-stage rTHA (32 patients) performed between January 2010 and July 2021, with a minimum two years follow-up. All patients received TM acetabular implants. Bone loss was classified according to Paprosky: 3 IIA, 8 IIB, 3 IIC, 12 IIIA, and 6 IIIB, with pelvic discontinuity in 13 cases.

Results: At mean follow-up of 30.2 ± 10.9 months (range, 24 to 69), infection eradication was achieved in 87,5%. Staphylococcus species accounted for 84,4% of cases. Seven complications occurred, including six reoperations: five revisions (two for recurrent infection, 3 for mechanical failure). The overall failure rate was 21,9%. At 24 months, the healing rate, including all causes of failure, was 78,1% and revision-free rate 84,4%.

Conclusion: TM implants in two-stage rTHA for septic failure achieved satisfactory mid-term results, even in advanced acetabular bone loss (44% Paprosky II, 56% Paprosky III). To our knowledge, this is the first study exclusively evaluating TM in this context, supporting its role in complex acetabular reconstruction during septic revisions.

Level of evidence: IV.

Purpose: To compare, in two groups of patients, the prognosis of unplanned resections of soft tissue sarcomas treated in a specialised centre, in terms of survival, local recurrence and complications.

Methods: A retrospective investigation was performed between 2006-2016. A total of 191 patients were included. 147 (77%) were included in the control group (planned reactions) and 44 (23%) corresponded to the study group (unplanned resection). The control group, patients underwent primary limb salvage surgery by the orthopaedic oncology team and the study group those who were initially treated at another center and required a second oncologic surgery to achieve free margins. Overall survival, local recurrence, postoperative complications and prognostic factors were analyzed.

Results: Overall survival at five years was 67% (95% CI: 62-76%). Compared to both groups, there was no significant difference (p = 0.22). The risk of LR at five years was 19.1% (95% CI: 18.89-19.30) for the control group and 35.64% (95% CI: 34.56-36.11) for the control group. for the study group (p = 0.047). Postoperative complications were significantly higher in the study group, 45% versus 21% (p < 0.01). We found a greater number of small tumours in the unplanned resection group.

Conclusions: Unplanned resection of extremity soft tissue sarcomas does not affect the overall survival of patients, but has a higher risk of local recurrence, a higher risk of developing postoperative complications and a lower chance of limb preservation. This study underscores the importance of thorough preoperative evaluation, particularly for small (< 5 cm) soft tissue tumours of the limb, and supports referral to specialised centres for optimal management.

Background: Posturography is a diagnostic technique that quantifies postural control through Centre of Pressure (CoP) displacement analysis on a force platform. Footwear characteristics, particularly heel-to-toe drop, may influence balance by modifying plantar pressure distribution and proprioceptive feedback. The aim of this study was to evaluate the impact of different footwear drops (0 mm, 5 mm, 10 mm) on postural control in healthy young adults, considering sex, BMI, and shoe size.

Methods: A cross-sectional study was conducted in 117 participants (56 men, 61 women) using the Dinascan/IBV^® platform and the Romberg test. CoP displacement and velocity were analyzed.

Results: Significant differences were observed in CoP total displacement (p < 0.001), mean velocity (p < 0.001), and medio-lateral dispersion (p = 0.024) when comparing 0 mm to 5 mm and 10 mm drops. Sex differences were significant at 0 mm drop for maximum medio-lateral force (p < 0.001) and mean velocity (p = 0.042), with men exhibiting greater values. At 5 mm drop, men showed significantly higher swept area (p = 0.029) and anteroposterior displacement (p = 0.007) than women.

Conclusions: Small variations in footwear drop can affect postural control, particularly in the medio-lateral plane. Sex and BMI significantly influence CoP behavior, suggesting the need to consider these factors in footwear design and clinical balance assessments.

Purpose: Calcium pyrophosphate dihydrate (CPPD) deposition, often visible radiographically as chondrocalcinosis, frequently accompanies knee osteoarthritis and is usually encountered at the time of arthroplasty. Whether its presence influences the outcome of patellofemoral arthroplasty (PFA) remains uncertain.

Methods: We reviewed 100 PFAs performed in 82 patients between 1997 and 2005, and followed them for an average of 22 years (range, 20-25 years). At surgery, 35 knees showed radiographic chondrocalcinosis, and an additional 33 developed calcification during follow-up.

Results: Fifteen knees (15%) required revision to total knee arthroplasty (TKA) at a mean of 12 years after PFA. The main reasons for revision were tibiofemoral osteoarthritis progression (6 knees), patellar malalignment (7 knees), one implant loosening, and one patella fracture. The 20-year survival rates were 87% for knees without chondrocalcinosis and 90% for those with chondrocalcinosis, with no significant difference in revision timing between groups (log-rank p = 0.64).

Conclusion: Although chondrocalcinosis became more prevalent with age and follow-up, it did not increase the risk of conversion to TKA. These findings suggest that PFA remains a suitable option in carefully selected patients, regardless of the presence of chondrocalcinosis.

Overstuffing can be defined as too much stuff in a limited space. In anatomic shoulder arthroplasty, overstuffing is a principal cause of postoperative pain, stiffness and limited function. This article reviews the concept of overstuffing in shoulder arthroplasty and how it can be avoided.

Introduction: Medical registries are structured tools for collecting, monitoring, and analyzing clinical data for epidemiological purposes, as well as for improving patient care. In the field of orthopaedics, arthroplasty registries help monitor implant performance, identify complications, and standardize surgical practices. In Burkina Faso, despite the increase in the number of joint replacements and epidemiological features such as sickle cell disease, no national registry exists. This work aims to establish a prototype of a registry tailored to local realities.

Methods: A cross-sectional descriptive study was conducted, combining a literature review to assess the existing situation and a questionnaire survey administered to orthopaedic surgeons in Burkina Faso. The analysis was conducted with Python 3.12.3, integrating descriptive statistics, visualizations, and synthesis of functional expectations.

Results: To date, there is no structured system for monitoring orthopaedic implantable devices at the national level. Orthopedists during the survey expressed the need for a centralized, secure, and accessible system, allowing the traceability of implants, the monitoring of complications, and the production of reports that can guide the choice of prostheses. Priority features include web and smartphone access, prosthesis survival statistics, and implant selection recommendations. The main constraints identified are the lack of a homogeneous IT infrastructure and limited financial resources. Based on the needs collected, a prototype was modeled, including UML diagrams, specifications, and web and smartphone models.

Conclusion: The establishment of a national arthroplasty registry is perceived as a strategic lever by practitioners to improve the quality of care and strengthen the surveillance of implantable devices. The prototype is intended to be a contextual, secure, and scalable solution. A pilot phase is recommended, with strong institutional support (Ministry of Health, National Orthopedics society) and participatory governance to ensure user buy-in and the sustainability of the registry.

Purpose: Femoral neck fractures in nongeriatric patients pose a significant clinical challenge due to the high clinical failure rate. To address this, Alpha fixation and the Femoral Neck System (FNS) were developed but seldom been compared head-to-head. The purpose of this study was to compare the clinical prognosis of these two methods with traditional parallel screws.

Methods: This retrospective cohort study included 341 patients aged 18-65 years, treated between June 2020 and June 2023. Patients were grouped by fixation strategies: (1) parallel screws (n = 206), (2) Alpha fixation (n = 73), and (3) FNS (n = 62). Fixation failure (nonunion, severe femoral neck shortening, varus collapse) was compared as primary clinical outcome using univariate and multivariate analyses. Secondary outcomes included avascular necrosis and reoperation rates. Analyses were stratified by Pauwels classification.

Results: Fixation failure rates were highest with parallel screws (21.4%), intermediate with FNS (12.9%), and lowest with Alpha fixation (9.6%). Multivariate analysis showed significantly lower fixation failure with Alpha fixation compared to parallel screws (adjusted OR = 0.29, 95% CI: 0.10-0.73, p = 0.014). Alpha fixation significantly reduced femoral neck shortening (p = 0.017), whereas FNS significantly reduced varus collapse (p = 0.013). In Pauwels type III fractures, Alpha fixation and FNS both significantly reduced fixation failure rates compared to parallel screws; no difference was found in Pauwels types I-II.

Conclusions: Alpha fixation and FNS significantly outperformed parallel screws in reducing fixation failure in vertical femoral neck fractures among nongeriatric patients. Alpha fixation showed advantages in limiting femoral neck shortening, whereas FNS more effectively prevented varus collapse. For stable fractures, conventional parallel screws remain a reasonable choice.